‼ALERT These are the signs that it’s cre…See more

Medication adjustments are often necessary in managing chronic diseases, but they can sometimes trigger unexpected side effects. This case involves a **55-year-old woman** with **hypertension** and **chronic obstructive pulmonary disease (COPD)** who developed an acute skin reaction shortly after switching her inhaler, emphasizing the importance of vigilance and early intervention.

The patient had been taking **enalapril** for blood pressure and using a **formoterol inhaler** for COPD. As her symptoms—shortness of breath and wheezing—worsened, her doctor changed her treatment to a **combination inhaler** containing **indacaterol** (LABA) and **glycopyrronium** (LAMA) for better control.

Within **two days** of starting the new inhaler, she developed **painful red patches** on her **face and neck**, along with mild fever and burning discomfort. She denied using new skincare products or experiencing sunburn, raising suspicion of a **drug-induced skin reaction**.

Her doctor promptly referred her to a **dermatologist**, who observed **erythematous, tender patches** consistent with a possible **medication reaction**. The inhaler was immediately discontinued, and a **skin biopsy** and **blood tests** were ordered to rule out infections or autoimmune conditions.

She was started on a **short course of oral corticosteroids**, leading to rapid improvement within **48 hours**, supporting the diagnosis of an **inflammatory or allergic reaction** rather than an infection.

This case highlights key clinical lessons:

1. **Inhaled drugs** can still cause **systemic side effects**, including skin reactions.
2. Any **new rash** appearing after a medication change should raise **suspicion for drug reaction**.
3. **Prompt discontinuation** and **early dermatology referral** can prevent worsening symptoms.
4. Patient-specific factors, such as **smoking** and **multiple chronic conditions**, may influence risk.

**Conclusion:**
While combination inhalers are generally safe, clinicians must remain alert to potential adverse reactions. **Early recognition**, **drug withdrawal**, and **supportive care**—as seen in this case—can ensure quick recovery and prevent complications. Patients should be encouraged to report **new symptoms** immediately after medication changes.